CIN 1

Often, cells showing CIN 1 will return to normal without any treatment at all. If your colposcopist decides not to treat these minor changes, they will arrange for you to have further screening tests or colposcopy, or both. This is to make sure that any further changes are found quickly.

CIN 2 and 3

Most doctors and researchers agree that CIN 2 and 3 should be treated. The aim of treatment is to remove the abnormal area, while causing as little damage as possible to surrounding healthy tissue. It’s also possible to destroy the abnormal cells, rather than remove them, although this isn’t commonly done.

Ways of removing the abnormal area include:

• large loop excision of the transformation zone (LLETZ), which is currently the most commonly used method of treatment
• a cone biopsy
• a hysterectomy or trachelectomy, although this is rare.

Ways of destroying the cells in the abnormal area so that normal cells can grow back in their place include:

• laser therapy
• cold coagulation
• cryotherapy.

Most women only need one of the treatments described here. All of the treatments are usually very effective at removing the abnormal cells. The type of treatment you have will depend on a number of factors. These include:

• the facilities available at your local hospital
• the type of treatment that your doctor thinks is best for you.

It may be possible for the treatment to be done at the same time as your initial colposcopy appointment, or you may have to come back at a later date.

LLETZ, laser therapy, cryotherapy, cold coagulation and sometimes cone biopsies are usually done in a hospital outpatient clinic using a local anaesthetic. This means that you can go home after treatment. It can be helpful for someone to come with you while you’re having treatment or pick you up afterwards.

Don’t be afraid to ask the colposcopist any questions about your treatment. Before your treatment, the nurse will help you lie comfortably on the couch. The colposcopist will then use a speculum so that they can see your cervix.

Try to relax as much as possible. The treatment itself is likely to take around 5–10 minutes. It may be uncomfortable but it isn’t painful.

The following are procedures to remove or destroy the abnormal area of the cervix.

Large loop excision of the transformation zone (LLETZ)

LLETZ is the most commonly used treatment for removing abnormal cells from the cervix. It’s sometimes called LEEP (loop electrosurgical excision procedure). It takes about 5–10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, you may need a general anaesthetic.

Once you’re in a comfortable position, the colposcopist will put some local anaesthetic into your cervix to numb it. The colposcope helps them to see a magnified image of your cervix. They remove the abnormal tissue using a thin wire loop. The loop is heated with an electric current, which cuts and seals the tissue at the same time. This shouldn’t cause any pain although you may feel some pressure inside your cervix.

The tissue will be sent off to a laboratory to be checked and to confirm the type of abnormal cell changes. Depending on the result, your colposcopist will decide whether you need to be followed up either at the colposcopy clinic or with your GP.

LLETZ is not usually painful. You may feel a period-like pain or a burning sensation. After the treatment, you may have some light bleeding or discharge. This can last for around four weeks. Your doctor or nurse will give you more information about what to expect after your treatment.

Cone biopsy

This is another treatment for CIN that involves removing abnormal tissue from the cervix.

A cone biopsy is usually carried out under a general anaesthetic, but sometimes a local anaesthetic may be given. The doctor uses a scalpel (a sharp tool) to take a small, cone-shaped piece of tissue from the cervix, which will be examined under a microscope. Afterwards, a small pack of gauze (like a tampon) may be put into the vagina to prevent bleeding. This is usually removed within 24 hours before you go home. Some women may also have a tube (catheter) put into the bladder to drain urine while the gauze pack is in place.

It’s normal to have some light bleeding and discharge for around four weeks. You should avoid any sex and strenuous exercise for at least four weeks to allow the cervix to heal properly.

Sex after LLETZ or a cone biopsy

Having a LLETZ or a cone biopsy will not affect your ability to enjoy sex once your cervix has healed. You should avoid sex, swimming, tampons and baths until the cervix has healed and any bleeding has stopped. Your colposcopist will give you more information about this.

Fertility after LLETZ or a cone biopsy

Very rarely, the cervix can become tightly closed after treatment. This is known as stenosis. It can make it harder for the sperm to enter the womb and so can affect your chances of becoming pregnant naturally. Your cervix is not completely closed if you’re still bleeding during your periods.

Pregnancy after LLETZ or a cone biopsy

Sometimes treatment can make the cervix slightly weaker. This is unlikely with a single treatment. But if you need more than one treatment, the cervix may weaken. Very rarely, this may mean that towards the end of a pregnancy, when the baby is bigger, the weakened cervix may start to open early causing a premature birth. To stop this happening, a stitch may be put into the remaining part of the cervix during pregnancy. The stitch is removed before you go into labour. Your doctor will discuss this with you if you’re concerned about future pregnancies.

Laser therapy or laser ablation

Under local anaesthetic, a laser beam is directed at the abnormal areas of your cervix and the cells are destroyed. During the treatment, you may notice a slight burning smell from the laser. This is normal.

Cold coagulation

This is a misleading name as the abnormal cells are removed by heating, not cooling. Firstly, a local anaesthetic is given to numb your cervix. Then a hot probe is placed onto its surface to destroy the abnormal cells.

Cryotherapy

You may be given a local anaesthetic, and a probe will be put on your cervix to freeze the abnormal cells. Cryotherapy has a slightly lower success rate than the other treatments for CIN, so it is not often used.

These types of surgery are rarely needed for CIN.

Hysterectomy

This is an operation to remove the womb and cervix. It is sometimes done for recurrent, persistent or high-grade CIN if you have other gynaecological problems. You will usually have a hysterectomy if you are past childbearing age, or don’t want to have more children.

Your doctor may discuss with you whether to remove your ovaries during the surgery. Removing the ovaries will cause an early menopause if you haven’t had the menopause already.

Trachelectomy

It’s sometimes possible with a very early cancer to have an operation where the cervix is removed and the womb is left in place. This is called a trachelectomy. Because the womb is left in place, you can still become pregnant after this operation. A trachelectomy is mainly carried out in younger women with cervical cancer who still want to have children. Your doctor will be able to give you more information about whether this type of surgery is suitable for you.